Discussion in 'Ambulances and Equipment' started by futureemt, Dec 23, 2007.
The tube noise with a sprague scope makes me crazy. I'll stay with my Littmann.
My littman select was great for medic school and when I was working IFT.
I now have the master cardiology and would never go back. I can hear a blood pressure while going 70mph with the sirens on. And lung sounds are crystal clear.
Don't be afraid, the diaphragm will be fine. They are also replaceable if damaged. It wouldn't hurt to take the scope apart to clean it thoroughly once a week as well.
Yes it's pretentious, and yes it's expensive, but NIBP modes on monitors always fail when you need them most. Dual lumen, single tube steths are always a good bet.
Don't leave it in a rig when you're off shift and don't loan it out. Mine looks terrible from use and I'd notice if someone else was rocking it. Also, the tubing will last quite a while as long as you dont wear it around your neck.
The Littmann Master Cardiology has a hole in the diaphragm, so I take the bell and diaphragm apart and soak in death juice at the end of every shift, but use alcohol on the tubing and ear pieces.
Every suspect cdiff contact gets a soaking in bleach and water in the mop bucket.
Hello, My name is Colin. I have a problem.
I am starting to collect stethoscopes.
Collection wise, I have
Littman master classic II SE
Littman Cardiology III
Harvey DLX Triple head from Welch Allyn.
My everyday use scope for over a year was the Omron. It's $15 and honestly, it's better than any littman for basic uses such as blood pressures and lung sounds. Comes with lots of earpieces, diaphragms, bells, the whole nine yards. Dollar for dollar, it's the best stethoscope in the world, in my opinion. Here it is on amazon http://www.amazon.com/Omron-Sprague-Rappaport-Stethoscope-Black/dp/B000FERLKI
I then "upgraded" to a Cardio III that I found with a broken off tube in a spare ambulance. Cleaned it up, new tube, new diaphragms, and it works like new. And it's definitely better for EMS than the master cardiology. The problem with the master cardio is for patients with severe flexion, tiny arms, and kids, that big old single head just doesn't work well enough. A pediatric bell is VERY useful for getting into tight spaces for blood pressures. If I had to pick between the master cardio and the cardio 3, I'd go C3 every day. And if you're getting further along and want to be able to listen to parts of the heart or get into intercostal spaces, the pedi bell is important there too. The tunable diaphragm, however, is not a good design. You really don't get the best of both worlds. You get a modest diaphragm and a weak bell. I used it for about 6 months and went back to the omron because it's simply louder. My partner was always asking to use my omron or my cardio 3 over his master cardiology, because anytime he needed a small bell, he didn't have one for his scope. Alllheart is a good place to buy http://www.allheart.com/product.asp...6&cadevice=c&gclid=CNjCr-Lxt8YCFViRfgod_kUOUA
I recently got a Harvey DLX triple head after playing with one from a cardiologist and I can say hands down, this is the best non electric scope money can buy. It's modeled after Dr. Harvey's original design, and that man wrote the book on cardiology. It's a little more expensive than Littman, but it's seriously superior. I've never heard a mid-systolic click so loudly in my life. How does this translate to EMS? Corrugated diaphragm amplifies noise like you couldn't believe. Not the clearest noise (the flat diaphragm has that covered, the corrugated is designed for mid-ranged cardiac sounds like aortic regurgitation) but if you want to listen to lung sounds or take a BP, nothing short of an electronic scope will be as loud. And it has a serious bell that amplifies so unbelievably well that I can use it for pediatric use as well. I am honestly starting to like the bell more for blood pressures than the diaphragms, with how well it seals. It's made from trumpet brass, rather than steel, so no more hearing your fingers creak while you're trying to listen for a faint/weak BP in the back of a rig, and the warranty is much better than Littman (10 years defects, 5 years ANYTHING wrong) It also comes with pediatric sized diaphragms, sold separately, that just screw right on and off like the Omron, comes with a multitude of earpieces, comes with a nametag, and you can have it laser engraved for $10. Best place to buy is Steeles, they will sell you the very expensive accessory kit for only $10 when you buy the scope and laser engrave it for $10 as well. Is it worth the extra $30-60? You bet your butt. After using a cardio 3 for quite a while and using it side by side with the Harvey, the difference is night and day. http://www.steeles.com/products/welch-allyn-harvey-triple-head-stethoscope-5079-321
I suggest EVERYONE own an Omron Sprague Rappaport. You may like your littman's bling, but the omron is a better scope in every way but weight and overall build quality (it doesn't fall apart, it just doesn't have the fit and finish of Littman. But what can you expect for $12.50) And you won't have to worry about loaning it out or losing it, because it's DIRT cheap. If you want to buy a middle of the road littman like the master classic, don't even bother, the Omron is far, far superior, and if you got a little cash for christmas from your dad, like I did, skip the high end littman and go Harvey DLX (they offer a 2 head version as well that is the exact same price as the cardio 3, but I like the weirdness of the 3, and having 3 heads has actually been nice) and you'll soon understand why I say this. Also, it looks cooler and doesn't make nurses turn their noses up at you for being an EMT with a "cardiologist" scope because not even they have any idea what the Harvey DLX is. You may have a cardiologist try to swipe it though! Mine stays on my neck all the time for this reason.
You don't mind hauling around a stethoscope with three heads?
They do make holsters for the belt, and the harvey fits into the one I have used with my littman, but it never felt right.
I tell this to everyone who complains about the "Weight" of a scope around the neck. If you can't handle one pound around your neck, you probably shouldn't be lifting patients either! It feels strange having a scope round your neck the first few days you use it, no matter what it is, and that's where most people stop. Just keep your scope on your neck, no matter what you use, and you'll get used to it in a few days, and you'll find it's actually pretty darn convenient a lot of times. Many times I've taken lung sounds on patients well before they got near my rig while fire was getting the backboard and extrication tools, or you'll be on scene with a medic who didn't bring his scope out of his rig, so you can toss him yours. Hell, I've had physicians want to borrow my ears because they don't like using the crap ER supplied ones and noticed I have a proper scope (proper being anything but the $5 pencil-thin plastic pieces of junk that hospitals seem to think are appropriate)
It's like Trauma shears. Always keep trauma shears on your person, because you WILL need them when you aren't near your rig (I keep tape too, but that's because I use tape a lot more than most people)
My scope lives in my pocket until I need it. Not worth keeping it on my neck when working on the road, given the ratio of time using vs. not using during the day.
I do think that for most prehospital use, "loud" is more important than having tremendous articulation of your next rheumatic fever patient's murmurs. But insulation is more important than either, and most people find that dual-tube design like the Sprague cause a lot of rubbing.
I think I covered the "loud" part pretty well. Corrugated diaphragms and proper open bells are louder than anything littman makes, and the trumpet brass isolates your ears so much better from the rumbling of our ancient ford 7.3 diesels. The direct contact diaphragm of the omron really is a superior diaphragm for simple amplification over a littman tunable, as well. Very basic but very effective.
I've heard the rubbing complaint for spragues, and while I've never personally noticed it as badly as the creaking of knuckles when holding onto the bell of a littman (whose dual lumen tubes are really bad at transmitting that sound) you can position the tube clamps in different places or remove them altogether if you want. Most people think all spragues are the same, but they really aren't. Omron makes a sprague that is miles beyond any other cheapie dual tube I've ever touched.
And holy hell you must have big pockets. Must just be personal preference, but I couldn't stand that kind of oddly shaped, bulky thing in a pocket. I hate when I have to put my PAGER in my pocket so I can ride my motorcycle to work. But that is, in all fairness, basically everyone's complaint about a scope around the neck, too, so whatever works.
And it doesn't matter what scope you use, or where you put it. They're all so close to the same, that a three head scope that weighs a third of a pound more than a master cardio will feel the same wherever you're used to keeping it, either round your neck or in your pocket.
A relatively FLAT headed scope (e.g. the Master Classic) sits nicely in a uniform pant dump pocket. But that was my point. Even a two-headed scope gets pokey, and with three heads I suspect it'd stay in my closet.
If that's the only place you can tolerate putting a scope, that's your choice. But I guarantee you've been in situations where a dual headed scope would have been beneficial, either on a pediatric patient, a tiny elderly patient (basically any time you have to pull out the infant or child sized BP cuffs) or someone with severe atrophy that cannot bend their arm. Sure, you can manage without, but why bother? I'd rather be used to having a scope around my neck that can do all the jobs properly than have a scope that costs just as much and doesn't. If you can't get a flat seal on the patient's arm, you're not going to get a clear pulse and you'll wind up using the bump on the sphygno to more or less guess where you're hearing the systolic come in, which might as well just be a palp'd pressure.
And the head isn't the worst part, I just tried putting my master classic into a dump pocket and the earpieces were poking everywhere. But again, personal preference.
My other complaint on the MCassic and Mcardio is that they don't encourage proper placement of the hand. You're not supposed to put your finger on the top of the bell as you press. You're supposed to hold it by the neck to get less interference from your own hand.
Sure, I use a Cardiology III in the office or ward. But in the field, auscultation is typically limited to lungs and blood pressures, and for those purposes I rarely find that I want more than "one size fits all."
But mileage and preferences obviously vary.
Guess I'm just picky about being able to hear very accurate blood pressures. I've had tiny, frail patients with BP's in the 190 systolic range that I simply could not hear with my partner's master cardio, but came in clear as day on my omron (which we just leave in the rig these days as our rig scope) with the pedi bell because I got a proper seal. One reason to own a decent scope is for diminished lung sounds, which I've found to not be easily discernable with a tunable littman, particularly if they're only very mildly beginning a tension pneumothorax. But you'd also see that in the oxygen saturation.
And, since we're on the topic of pocket scopes, you can simply unscrew and remove the top bell from the omron and the harvey DLX twin if you REALLY want it to fit in your pocket.. You can actually run the DLX 3 head with only two, and since they're close enough to being on the same side (only 120 degrees apart instead of 180) it fits in my pocket well with two bells on. Still feels wrong though. My legs bash into things all day, I feel like I'd just break my scopes prematurely that way.
Are you saying you've been able to appreciate a large number of subtle pneumothoraces due to diminished lung sounds? That's a pretty impressive catch.
I use an older Littmann electronic because I need to hear well in the back of a moving ambulance...which is not unlike being inside a drum being driven down the road. I have an acoustic Littmann which is fine and an Omrom (spelling?) which is almost as good, but the electronic is what I go to. I got it cheaply because it needed a new diaphragm. I am told that the Chinese electronic ones are good but I have not tried them.
A good pair of shears is probably desirable, they are not expensive. Most ambulances have a couple of pair, but they are cheap enough to own a pair. It save time looking in the vehicle. That time is not often critical for a basic, but sometimes it is.
Large? No. 2 confirmed, a few more possible? yes. Let's just say most of Seattle fire doesn't really understand blunt trauma induced pneumothorax without an unstable rib fx. I don't consider myself an exceptional EMT, and a patient with the beginnings of a pneumo is really not hard to spot. I did have a patient with an unstable rib fx after t-boning a fire truck a few weeks ago, and he was in the beginnings of a tension pneumo, to my ears his lower right lobe sounded diminished, but he could speak in full sentences and wasn't complaining of trouble breathing. Medic intercept confirmed the diminished lung sounds and a few days later I saw them and they confirmed he had an ongoing pneumo after a CHX.
Make sure to sit them upright to help localize it. Listen at the apices.
I recently switched from a Littmann Classic II (which I slammed repeatedly in the door, thought the seatbelt was stuck oops) to a Master Cardiology that a friend gave me once he retired. I have had none of the problems you describe throughout this thread. I cannot stand how uncomfortable those sprauges are, and the tubes hitting each other is also rather annoying. To insinuate that I'll be relying on the "needle bounce" because I don't have a dual head stethoscope is silly. I also do not loan my stethoscope to anyone but my partner, that's kind of icky.
Like many things, it comes down to personal preference. There are doubtless thousands of EMS providers that use Littmanns everyday without issue (to your high standards I am sure). It has nothing to do with bling, they work well, are comfortable and durable, and have a pretty excellent warranty. Also, the last time I cared what a nurse thought I looked like was wait for it...never.
Scopes are really like cell phones or car brands. Vehement loyalty. But hold a master cardio side by side to a harvey dlx and you would be able to tell the difference clearly. I don't want to put down a littman, I think the cardio 3 is fabulous. And littman fit and finish is superb. But you are paying an awful lot for the badge and a whole lot more beyond that for parts like tubing and diaphragms, and I don't like hearing everyone telling people that their first scopes should be littmans. Buy the scope you like the best, but be aware that there are high quality, cheap alternatives and even higher quality options. The more scopes I collect, the less "superior" the littmans get to my ears. That says nothing about being given a scope. Your master cardio was free, and nothing tops free. But I really don't understand single head only designs. Peds and pts with contractures make that gigantic head a nightmate to position propely for a b.p. And sharing scopes is hardly gross if you wipe your gear down. Earwax is hardly a noteworthy disease transmission conduit.
Nightmare is an exaggeration to significant proportions. As it turns out, a complete seal of the diaphragm is not necessary to use the device, especially to get a BP. And while I am not going to get Hep C from it, I really don't need someones earwax in my own ears. Bring your own if you want to hear what's what, and since my partner and I will be transporting, we are actually who needs to know.
There are certainly alternatives, they may suit some but not others. Most here are not suited to the 12 dollar variety.
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